Healthcare Provider Details

I. General information

NPI: 1487352068
Provider Name (Legal Business Name): LILYBET RODRIGUEZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9240 SW 72ND ST STE 241
MIAMI FL
33173-3265
US

IV. Provider business mailing address

11123 SW 128TH PL
MIAMI FL
33186-4709
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-1919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: LILYBET RODRIGUEZ
Title or Position: OWNER
Credential: PA
Phone: 786-253-5825